Healthcare Provider Details

I. General information

NPI: 1659658656
Provider Name (Legal Business Name): STEPHEN LIEBERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N UNION AVE
CRANFORD NJ
07016-5101
US

IV. Provider business mailing address

17 N UNION AVE
CRANFORD NJ
07016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 908-276-0062
  • Fax: 908-276-9450
Mailing address:
  • Phone: 908-276-0062
  • Fax: 908-276-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28R101355400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: